Development of a Novel Task-oriented Rehabilitation Program using a Bimanual Exoskeleton Robotic Hand

This robot-assisted, task-oriented training protocol was developed for patients with hand dysfunction caused by neurological deficits. Our protocol is the first to integrate task-oriented training program with a robotic hand for hand function rehabilitation and the first to investigate the feasibility and the acceptability of the protocol. We have designed specialized objects that can be manipulated using the training protocol.

Then our robotic hand system can be applied to bimanual movement training. Demonstrating the procedure will be Yi-Mei Chen and Szu-Shen Lai, occupational therapists from my department. Before beginning the analysis, place the sensor on the subject's unaffected hand, and use the hook-and-loop tape to secure the wrist.

Use a clean pad to wrap the affected hand, and securely fasten the hook-and-loop tape. Loosen the thumb mechanism of the exoskeleton hand to allow adjustment of the thumb-opening angle, and place the affected hand in the exoskeleton hand. Fasten the hook and loop to the palm through the fastening ring.

After that, fasten the fingers one by one, beginning with the forefinger and finishing with the thumb. Fasten the hook-and-loop tape parallel to the wrist through the fastening ring, and adjust the thumb to a comfortable angle. Then, tighten the thumb mechanism.

To set up the control box, insert the cable for the exoskeleton hand and insert the cable for the sensor glove. Insert both sets of cables into the socket in the control box, and insert the power cable into the control box. Then, connect the power cable to an outlet with the correct voltage.

When the system and subject are ready, switch to the control box, and set the mode to Five Fingers to allow the exoskeleton hand to move the subject's fingers passively. Ask the subject to perform a grasp-and-release task guided by the exoskeleton hand for 2.5 minutes. Switch the mode to Single Finger.

Then, let the exoskeleton hand move the subject's fingers individually and passively while the subject extends and retracts individual fingers for 2.5 minutes. For a robot-assisted bimanual movement session, switch the mode to Mirror to allow the movement of the unaffected hand wearing the sensor glove to control the exoskeleton hand movements. To conduct a trial of the subject's ability to manipulate objects using the robotic hand system, fit the exoskeleton hand to the subject's unaffected hand and the sensor glove to the unaffected hand as just demonstrated, and place a sling under the subject's elbow and exoskeleton hand to support the affected arm.

Next, conduct a warm-up session as just demonstrated. After the warm-up, use the robotic hand system for five minutes to demonstrate how to manipulate the designed objects, including using palmar prehension to pick up the peg, a lateral prehension to pick up the rectangular cube, a three-point chuck to pick up the cube, a spherical grasp to pick up the ball, and a cylindrical grasp to pick up the cylindrical bar. After the demonstration, place two bases bilaterally in front of the subject's hands, and place the objects onto the top of one base to assist in their manipulation.

Have the subject use the robotic hand system to grasp each object 20 times a day for three consecutive days, starting at the area of the base and lifting, moving, and releasing each object onto the midline while monitoring and recording the success rate for each attempt. In this representative analysis, three healthy subjects and three post-stroke subjects were assessed. The average age of the healthy group was 28, whereas the average age of the patient group was 49.

Mini-Mental State Examination, Fugl-Meyer Assessment, Modified Ashworth Scale finger, and Brunnstrom stage scores were also obtained for each patient. The subjects in the healthy group perfectly manipulated all of the objects with and without the robotic hand system, with an average success rate of 100%for every task. All of the patients, however, exhibited difficulties in manipulating the objects without the robotic hand system, demonstrating a 0%success rate for all of the objects.

In contrast, all of the patient success rates increased significantly when the robotic hand system was used, approaching rates similar to those observed in healthy subjects, supporting the feasibility of using the robotic hand system in stroke patients. Remind the subjects to concentrate on the movement control of their bilateral hands during bimanual movement training, making sure that the grasp patterns on the objects are correct. Following this procedure, a randomized controlled trial is required to determine the therapeutic effects of the training protocol.

Using this technique, researchers can program rehabilitation protocols with delicate finger movement for severe hand dysfunction and can explore the effects on brain neuroplasticity and functional outcomes.